scholarly journals Challenges in estimating HIV prevalence trends and geographical variation in HIV prevalence using antenatal data: Insights from mathematical modelling

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242595
Author(s):  
Leigh F. Johnson ◽  
Mmamapudi Kubjane ◽  
Jeffrey W. Eaton
Keyword(s):  
South Africa ◽  
Pregnant Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Geographical Variation ◽  
Sexual Experience ◽  
Hiv Prevalence ◽  
Hiv Incidence ◽  
African Countries ◽  
Prevalence Data

Background HIV prevalence data among pregnant women have been critical to estimating HIV trends and geographical patterns of HIV in many African countries. Although antenatal HIV prevalence data are known to be biased representations of HIV prevalence in the general population, mathematical models have made various adjustments to control for known sources of bias, including the effect of HIV on fertility, the age profile of pregnant women and sexual experience. Methods and findings We assessed whether assumptions about antenatal bias affect conclusions about trends and geographical variation in HIV prevalence, using simulated datasets generated by an agent-based model of HIV and fertility in South Africa. Results suggest that even when controlling for age and other previously-considered sources of bias, antenatal bias in South Africa has not been constant over time, and trends in bias differ substantially by age. Differences in the average duration of infection explain much of this variation. We propose an HIV duration-adjusted measure of antenatal bias that is more stable, which yields higher estimates of HIV incidence in recent years and at older ages. Simpler measures of antenatal bias, which are not age-adjusted, yield estimates of HIV prevalence and incidence that are too high in the early stages of the HIV epidemic, and that are less precise. Antenatal bias in South Africa is substantially greater in urban areas than in rural areas. Conclusions Age-standardized approaches to defining antenatal bias are likely to improve precision in model-based estimates, and further recency adjustments increase estimates of HIV incidence in recent years and at older ages. Incompletely adjusting for changing antenatal bias may explain why previous model estimates overstated the early HIV burden in South Africa. New assays to estimate the fraction of HIV-positive pregnant women who are recently infected could play an important role in better estimating antenatal bias.

scholarly journals HIV Incidence Among Non-Pregnant Women Living in Selected Rural, Semi-Rural and Urban Areas in Kwazulu-Natal, South Africa

2011 ◽  
Vol 16 (7) ◽  
pp. 2062-2071 ◽  
Author(s):  
Gita Ramjee ◽  
Handan Wand ◽  
Claire Whitaker ◽  
Sheena McCormack ◽  
Nancy Padian ◽  
...  
Keyword(s):  
South Africa ◽  
Pregnant Women ◽  
Urban Areas ◽  
Hiv Incidence ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Kwazulu Natal

HIV Incidence Remains High in KwaZulu-Natal, South Africa: Evidence from Three Districts

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
South Africa ◽  
Urban Areas ◽  
Contraceptive Use ◽  
Hormonal Contraceptive ◽  
Incidence Rates ◽  
Hiv Prevalence ◽  
Hiv Positive ◽  
Sexually Active ◽  
Hiv Incidence ◽  
Kwazulu Natal

Background: HIV prevalence and incidence among sexually active women in peri-urban areas of Ladysmith, Edendale, andPinetown, KwaZulu-Natal, South Africa, were assessed between October 2007 and February 2010 in preparation for vaginalmicrobicide trials.Methodology/Principal Findings: Sexually active women 18–35 years, not known to be HIV-positive or pregnant weretested cross-sectionally to determine HIV and pregnancy prevalence (798 in Ladysmith, 1,084 in Edendale, and 891 inPinetown). Out of these, approximately 300 confirmed non-pregnant, HIV-negative women were subsequently enrolled ateach clinical research center (CRC) in a 12-month cohort study with quarterly study visits. Women in the cohort studies wererequired to use a condom plus a hormonal contraceptive method. HIV prevalence rates in the baseline cross-sectionalsurveys were high: 42% in Ladysmith, 46% in Edendale and 41% in Pinetown. Around 90% of study participants at each CRCreported one sex partner in the last 3 months, but only 14–30% stated that they were sure that none of their sex partnerswere HIV-positive. HIV incidence rates based on seroconversions over 12 months were 14.8/100 person-years (PY) (95% CI9.7, 19.8) in Ladysmith, 6.3/100 PY (95% CI 3.2, 9.4) in Edendale, and 7.2/100 PY (95% CI 3.7, 10.7) in Pinetown. The 12-monthpregnancy incidence rates (in the context of high reported contraceptive use) were: 5.7/100 PY (95% CI 2.6, 8.7) inLadysmith, 3.1/100 PY (95% CI 0.9, 5.2) in Edendale and 6.3/100 PY (95% CI 3.0, 9.6) in Pinetown.Conclusions/Significance: HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal.

scholarly journals Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mingming Cui ◽  
Xiao-Lin Lu ◽  
Yan-Yu Lyu ◽  
Fang Wang ◽  
Xiao-Lu Xie ◽  
...  
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Unplanned Pregnancy ◽  
Urban China ◽  
Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

scholarly journals Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

2020 ◽  
Vol 5 (12) ◽  
pp. e002169
Author(s):  
Ngatho Samuel Mugo ◽  
Kyaw Swa Mya ◽  
Camille Raynes-Greenow
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Adolescent Mothers ◽  
Health Survey ◽  
Rural Areas ◽  
Urban Areas ◽  
Multinomial Logistic Regression ◽  
Wealth Quintile ◽  
Adjusted Risk ◽  
Factors Associated

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.

scholarly journals Returning home to die: Circular labour migration and mortality in South Africa 1

2007 ◽  
Vol 35 (69_suppl) ◽  
pp. 35-44 ◽  
Author(s):  
Samuel J. Clark ◽  
Mark A. Collinson ◽  
Kathleen Kahn ◽  
Kyle Drullinger ◽  
Stephen M. Tollman
Keyword(s):  
South Africa ◽  
Rural Areas ◽  
Urban Areas ◽  
Terminal Illness ◽  
Event History Analysis ◽  
Historical Period ◽  
Short Term ◽  
History Analysis ◽  
Working Age

Aim: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. Methods: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. Results: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. Conclusions: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.

scholarly journals Increase in Percentage of Seronegative Toxoplasma gondii and Cytomegalovirus in Pregnant Women: An Improvement in Hygienic Conditions in Certain Areas?

2020 ◽  
Vol 2020 (1) ◽  
pp. 1 ◽  
Author(s):  
Dan-Bogdan Navolan ◽  
Florin Gorun ◽  
Cristian Oancea ◽  
Ioana-Mihaela Ciohat ◽  
Daniel Malița ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Pregnant Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Infection ◽  
Food Quality Control ◽  
Fetal Infection ◽  
Increasing Trend ◽  
Urban And Rural Areas ◽  
Pathogenic Agents

(1) Background: Toxoplasma gondii and cytomegalovirus belong to a group of pathogens entities called TORCH agents. TORCH represents an acronym which derives from the name of a series of certain pathogenic agents (Toxoplasma gondii, Other agents, Rubella virus, Cytomegalovirus, Herpes virus). They could cross the placenta barrier and cause serious damage to the fetus if a primary infection occurs in a pregnant woman. Immunized women are relatively protected against a reinfection and the risk of a materno-fetal infection in these categories of pregnant women is considered low. (2) Aim of the study: To analyze changes in the percentage of pregnant women seronegative to Toxoplasma gondii and cytomegalovirus along a period of ten years, from 2008 to 2018. (3) Material and Methods: We studied the changes in percentage of seronegative Toxoplasma gondii and Cytomegalovirus pregnant women along two periods: 2008–2010 and 2015–2018. Only pregnant women with declared medium of provenience and unequivocal results were enrolled in the study. (4) Results: In urban areas, we found an increase in the percentage of pregnant women seronegative to Toxoplasma gondii (RR = 1.488, p < 0.0001), respectively to cytomegalovirus (RR = 1.985, p < 0.0001), from 2008–2010 to 2015–2018. A similar increasing trend was found also in rural areas: Toxoplasma gondii (RR = 1.136, p < 0.0322), respectively cytomegalovirus (RR = 1.088, p < 0.8265) but it did not reach a significant threshold for cytomegalovirus. (5) Conclusion: Our study showed that the percentage of women seronegative to Toxoplasma gondii and cytomegalovirus antibodies increases along a period of ten years, from 2008–2010 to 2015–2018, in both urban and rural areas. Probably, the main cause of this trend is represented by the improvement in hygienic condition and food quality control. These results present an argument for continuing the TORCH screening of pregnant women.

Proximity to sex work sites is not associated with higher HIV prevalence in the general population in Zimbabwe

2021 ◽  
Author(s):  
Mariëlle Kloek ◽  
Caroline Bulstra ◽  
Sungai Chabata ◽  
Elizabeth Fearon ◽  
Isaac Taramusi ◽  
...  
Keyword(s):  
General Population ◽  
Sex Work ◽  
Sex Workers ◽  
Hiv Prevalence ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Prevalence Data ◽  
Individual Level ◽  
Shortest Distance ◽  
Survey Sample

Abstract In Zimbabwe, as in other East and Southern African countries, HIV prevalence is largely geographically heterogeneous. We determined if, and to what extent, this heterogeneity is associated with proximity to sex work sites by type of site (city, economic growth point, international, seasonal, or transport), using Demographic and Health Surveys location-specific HIV prevalence data—including 16,121 individuals (aged 15-49 years) from 400 sample locations—and Centre for Sexual Health and HIV/AIDS Research data on locations of 56 sex work sites throughout Zimbabwe. We conducted univariate and multivariate multilevel logistic regression to determine the association between sex work proximity—calculated as the shortest distance by road from each survey sample location to the nearest sex work site—and HIV seropositivity. We found no association between locations of sex work and heterogeneity in HIV prevalence in the general population, possibly explained by the mobile nature of both female sex workers and their clients as individual-level indicators of sex work were still significantly associated with HIV.

The Paradox of (De)politicisation in a Selected South African Municipality: An Afrocentric Ethical Reflection

Politeia ◽  
2019 ◽  
Vol 38 (2) ◽  
Author(s):  
Kgothatso B. Shai
Keyword(s):  
South Africa ◽  
Local Government ◽  
Rural Areas ◽  
Urban Areas ◽  
Local Governance ◽  
African National Congress ◽  
Limpopo Province ◽  
African Culture ◽  
Government Administration ◽  
Traditional Leadership

South Africa’s local government administration is complex in that both traditional leadership and elected municipal councils play a role in it. Traditional leadership occupies an essential position and status in local government administration, in particular in rural South Africa. However, the contemporary administrative jurisdiction of municipalities cuts across both rural and urban areas. In the rural areas, the conflict over the division of roles between traditional leaders and elected councillors is evident. Due to the influence and dominance of the neo-liberal global order, modernists often accuse traditional leadership of being undemocratic and authoritarian. However, the reality is that elected councils’ administration also leaves much to be desired, and the consequences of their poor administration are not uniformly understood. Since South Africa is a democratic state, it is expected that there should be a clear separation in government institutions between party (i.e., the ruling African National Congress) politics and public administration; a phenomenon that some describe as depoliticisation. Nevertheless, the realities on the ground suggest otherwise. This article, which is based on the theory of Afrocentricity, examines a selected rural municipality (Maruleng) in South Africa’s Limpopo province to critically reflect on the ethics and the value system of African culture in the context of local governance vis-à-vis Westernised governance principles. The aim of this research is achieved through interdisciplinary critical discourse and thematic analysis in its broadest form.

DEATH ‘ON THE MOVE’: FUNERALS, ENTREPRENEURS AND THE RURAL–URBAN NEXUS IN SOUTH AFRICA

Africa ◽  
2011 ◽  
Vol 81 (2) ◽  
pp. 226-247 ◽  
Author(s):  
Rebekah Lee
Keyword(s):  
South Africa ◽  
South African ◽  
Rural Areas ◽  
Urban Areas ◽  
Eastern Cape ◽  
Funeral Directors ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Cultural Mediators ◽  
The Dead

ABSTRACTThis article primarily concerns the intersection of the changing management of death with the problems and possibilities presented by the growing mobility of the African, and specifically Xhosa-speaking, population in South Africa from the latter half of the twentieth century to the present day. I am interested in how shifts in the practices and beliefs around death are mediated by individuals, households and businesses who have an historical affinity towards movement, particularly across what has been called the ‘rural–urban nexus’. In what ways has this more mobile orientation influenced the perception of rites and responsibilities surrounding death? And how have more mobile ‘ways of dying’ in turn created new subjectivities and new ways in which to imagine relations between the living and the dead? I argue that African funeral directors based in Cape Town and the rural areas of the Eastern Cape – a steadily more numerous and prominent group of entrepreneurs – are well-placed to shape these processes, through their role as cultural mediators and technological innovators, and their particular emphasis on maintaining a flow of bodies (both dead and alive) between rural and urban areas. I focus on two aspects of contemporary South African funerals – embalming and exhumations – that are suggestive of how the migration dynamic, and the continuing demands from mobile mourners for innovations via the funeral industry, have encouraged new perceptions of and relations to the dead body.

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